• Journal of Trauma and Injury
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• v.35 no.1
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• pp.66-70
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• 2022

The spleen is the most commonly injured organ after blunt abdominal trauma. Nonoperative management (NOM) is the standard treatment for blunt splenic injuries in haemodynamically stable patients without peritonitis. Complications of NOM include rebleeding, new pseudoaneurysm formation, splenic abscess, and symptomatic splenic infarction. These complications hinder the NOM of patients with blunt splenic injuries. We report a case in which a large haemorrhagic fluid collection that occurred after angio-embolisation was resolved by percutaneous drainage in a patient with liver cirrhosis who experienced a blunt spleen injury.

• Journal of Trauma and Injury
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• v.28 no.4
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• pp.241-247
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• 2015

Purpose: To evaluate the influence of how the trauma care system is applied on the management of trauma patients. Methods: We divided the patients into a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in our institution. We compared the general characteristics, injury severity score, initial response time to the trauma patients, number of preventable deaths, and clinical outcomes between the two groups. Results: The numbers of patients in the pre-trauma system group and the post-trauma system group were 188 and 257, respectively. No differences in the patient's median ages, trauma scores (ISS, RTS, TRISS) and proportions of severe trauma patients (ISS>15) were observed between the two groups. The number and the proportion of patients who were admitted to our hospital were increased in the post-trauma system group. The time interval from trauma CP activation to emergency surgery or angio-embolization, and the patient's time spent in emergency room were shortened in the post-trauma system group. However, the lengths of the ICU stay and the hospital stay, and the number of in-hospital mortalities were not improved in the post-trauma system group. In severe trauma patients (ISS>15), there were no differences between the two groups in the number and the proportion of admitted patients, and the time interval from trauma CP activation to performing a diagnostic and therapeutic procedure was not shortened in the post-trauma system group. Conclusion: Application of the trauma care system has shortened the time between the initial response and patient management. However, this improvement was not enough to result in better clinical outcomes. More trauma physicians, multidisciplinary cooperation, and a well-organized trauma management process will be needed if the maximum efficacy of the trauma system is to be achieved.

• Journal of Trauma and Injury
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• v.26 no.2
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• pp.53-57
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• 2013

A duodenal diverticulum is a frequent abnormality that is usually diagnosed incidentally. Clinical manifestations usually mimic those of highly-varied entities. Among the complications of a duodenal diverticulum, perforation is fairly rare; rupture due to blunt trauma is even rarer, and no cases have been reported in Korean literature. We report the case of a 61-year-old male patient who presented with a perforated duodenal diverticulum after a blunt trauma. We also review the existing literature.

• Journal of Trauma and Injury
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• v.37 no.1
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• pp.74-78
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• 2024

Inferior vena cava (IVC) injuries can have fatal outcomes and are associated with high mortality rates. Patients with IVC injuries require multiple procedures, including prehospital care, surgical techniques, and postoperative care. We present the case of a 67-year-old woman who stabbed herself in the abdomen with a knife, resulting in an infrarenal IVC injury. We shortened the transfer time by transporting the patient using a helicopter and decided to perform direct-to-operating room resuscitation by a trauma physician in the helicopter. The patient underwent laparotomy with IVC ligation for damage control during the first operation. The second- and third-look operations, including previous suture removal, IVC reconstruction, and IVC thrombectomy, were performed by a trauma surgeon specializing in cardiovascular diseases. The patient was discharged without major complications on the 19th postoperative day with rivaroxaban as an anticoagulant medication. Computed tomography angiography at the outpatient clinic showed that thrombi in the IVC and both iliac veins had been completely removed. Patients with IVC injuries can be effectively treated using a trauma system that includes fast transportation by helicopter, damage control for rapid hemostasis, and expert treatment of IVC injuries.

• Journal of Trauma and Injury
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• v.35 no.4
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• pp.291-296
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• 2022

The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention.

• Archives of Plastic Surgery
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• v.50 no.5
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• pp.501-506
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• 2023

This article portrays the authors' experience with a complex lower limb bone and soft tissue defect, following chronic osteomyelitis and pathological fracture, which was managed by the multidisciplinary orthoplastic team. The decision for functional amputation versus limb salvage was deemed necessary, enhanced by the principles of "spare parts" in reconstructive microsurgery. This case describes the successful use of the osteocutaneous distal tibia turn-up fillet flap that allowed "lowering the level of the amputation" from a through knee to a below-knee amputation (BKA) to preserve the knee joint function. We comprehensibly review reports of turn-up flaps which effectively lower the level of amputation, also applying "spare-parts" surgery principles and explore how these concepts refine complex orthoplastic approaches when limb salvage is not possible to enhance function. The osteocutaneous distal tibia turn-up fillet flap is a robust technique for modified BKA reconstructions that provides sufficient bone length to achieve a tough, sensate stump and functional knee joint.

• Health Policy and Management
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• v.28 no.4
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• pp.411-422
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• 2018

Background: Whether there is a difference in outcomes for trauma patients transferring to the helicopter emergency medical service (HEMS) according to their previous team composition is controversial. The purpose of this study is to evaluate the effectiveness of trauma team-staffed-HEMS (TTS-HEMS) when transferring to a trauma center. Methods: A retrospective comparison was conducted on patients transported to a trauma center over a 6-year period by the TTS-HEMS and paramedic-staffed-HEMS (119-HEMS). Inclusion criteria were blunt trauma with age ${\geq}15years$. Patient outcomes were compared with the Trauma and Injury Severity Score (TRISS) (30-day mortality) and the Cox proportional hazard ratio of mortality (in hospital). Results: There were 321 patients of TTS-HEMS and 92 patients of 119-HEMS. The TTS-HEMS group had a higher Injury Severity Score and longer transport time but a significantly shorter time to emergency surgery. The prehospital data showed that the trauma team performed more aggressive interventions during transport. An additional 7.6 lives were saved per 100 TTS-HEMS deployments. However, the TRISS results in the 119-HEMS group were not significant. In addition, after adjusting for confounders, the hazard ratio of mortality in the 119-HEMS group was 2.83 times higher than that in the TTS-HEMS group. Conclusion: HEMS was likely to improve the survival rate of injured patients when physicians were involved in TTS-HEMS. Survival benefits in the TTS-HEMS group appeared to be related to the fact that the trauma team performed both more aggressive prehospital resuscitation and clinical decision making during transportation.

• Journal of Trauma and Injury
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• v.35 no.1
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• pp.61-65
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• 2022

Traumatic abdominal wall hernia is a very rare clinical entity. Herein, we report the case of a patient who was transferred from a local clinic to the emergency department because of left lower abdominal pain. Initially, an intra-abdominal hematoma was observed on computed tomography and no extravasation was noted. Conservative treatment was initiated, and the patient's symptoms were slightly relieved. However, though abdominal pain was relieved during the hospital stay, bowel herniation was suspected in the left periumbilical area. Follow-up computed tomography showed traumatic abdominal wall hernia with hemoperitoneum in the abdomen. We performed a laparoscopic exploration of the injury site and hernia lesion. The anterior abdominal wall hernia was successfully closed.

• Journal of Trauma and Injury
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• v.30 no.3
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• pp.103-106
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• 2017

A traumatic Braun-Sequard syndrome of the cervical spine is reported in a 53-year-old male. The patient recovered spontaneously over several days with surgical intervention. The diagnosis was made on magnetic resonance imaging with physical examination, which also demonstrated subsequent resolution of bone marrow intensity. The etiological factors of spinal Braun-Sequard syndrome are reviewed.

• Journal of Trauma and Injury
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• v.31 no.2
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• pp.87-90
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• 2018

Non-operative management has been preferred in blunt spleen injury. Moreover children are more susceptible to post-splenectomy infection, spleen should be preserved if possible. However, splenectomy is inevitable to patients with severe splenic injury. Therefore splenic autotransplantation could be the last chance for preserving splenic function in these patients although efficacy has not proven. Here we reported four cases of children who were underwent splenic autotransplantation successfully after blunt trauma.